Dr Catarina Duarte - Rhinoplasty
What is Rhinoplasty?
Rhinoplasty (nose surgery) is a surgical procedure that aims to improve the appearance, structure and function of the nose. Rhinoplasty can increase or decrease the size of the nose, change the shape of the tip, narrow the base of the nostrils or change the angle between the nose and the lip. This operation can help correct birth defects and the after-effects of trauma.
There is no universal way of carrying out rhinoplasty, and planned according to each patient's wishes and anatomical characteristics. In some cases, cartilage grafts are needed, which can be harvested from the nasal septum, the auricular pavilions (ears) or the costal grid (ribs) to help reshape the nose.
A Rhinoplasty should always take into account both aesthetic and functional aspects. Obviously, you can't have an aesthetically perfect nose in which you can't breathe properly. Among the possible approaches for a rhinoplasty aimed at improving the appearance of the nose, exonasal or endonasal routes can be used (outside or inside the nose, respectively). If there is a complex functional pathology, the Plastic Surgeon's work should be complemented by that of an Otorhinolaryngologist, preferably in the same procedure.
Who it's for
Rhinoplasty?
Rhinoplasty is ideally indicated for patients who:
- They are dissatisfied with the appearance of their nose (these can be genetic defects or acquired deformities resulting from trauma);
- They have functional problems with their nose (deviated nasal septum, nasal polyps, turbinate hypertrophy, chronic nasal obstruction, headaches, recurrent episodes of sinusitis, etc);
- They are in good general health;
- They are non-smoking;
- They are emotionally stable and have realistic expectations about the results of the surgery;
- They try to improve the appearance of the nose, not its perfection.
What aesthetic features of the nose can
be improved with Rhinoplasty?
Rhinoplasty is indicated for patients with one or more of the following complaints:
- Big, wide nose;
- “Nasalised ”Bossa";
- The tip of the nose is large and rounded (“potato nose”);
- Tip of the nose drooping and/or too close to the upper lip;
- Wide nostrils.
Types Rhinoplasty
Open Rhinoplasty
Open Rhinoplasty consists of making small incisions in the columella - the narrow tissue that separates the two nostrils - and on the sides of the nostrils. The skin is then lifted so that the nasal structure is fully exposed for better visualisation. The nose is then remodelled and bone, cartilage or tissue is removed or added until the desired appearance is achieved.
Advantages of Open Rhinoplasty:
- It allows direct visualisation of bone structures;
- It allows a very clear assessment of deformities, irregularities and asymmetries of the nose;
- It facilitates a precise diagnosis;
- Allows the plastic surgeon to manipulate with two hands;
- It allows for a greater number of tissue and cartilage grafting techniques.
Disadvantages of Open Rhinoplasty:
- It involves an external scar, although it is quite discreet (on the columella);
- Longer operating time;
- Longer swelling, especially at the tip of the nose;
- Late or unsightly healing.
Closed Rhinoplasty
In Closed Rhinoplasty, the plastic surgeon makes small incisions inside the nostrils to access the bone and cartilage. The skin is not detached from the bone structures, as in open rhinoplasty, so there is no direct visualisation of the bone structures.
Advantages of Closed Rhinoplasty:
- No external scar;
- Less post-operative swelling;
- Faster - shorter operating time;
- Faster recovery;
- It facilitates a precise diagnosis;
- Allows the plastic surgeon to manipulate with two hands;
- It allows for a greater number of tissue and cartilage grafting techniques.
Disadvantages of Closed Rhinoplasty:
- It does not allow direct visualisation of bone structures;
- The intervention is carried out through “tactile sensations”;
- It requires a greater degree of experience and specialisation;
- Visualisation is limited to just one person;
- The success of the surgery is also more dependent on preoperative diagnosis than in open rhinoplasty.
Surgery Procedure Nose Correction
Rhinoplasty Consultation
Counselling
The first step in your rhinoplasty consultation (Lisbon, Porto or Cascais) is to share with the medical team your complaints (aesthetic and/or functional), your expectations of the surgery and the result you want to achieve.
2D/3D simulation
The simulation gives you an idea of the results you can achieve with a rhinoplasty.
Detailed explanation
During the rhinoplasty consultation, a treatment plan will be outlined and the risks of surgery, pre- and post-operative care and the results you can expect will be explained.
Budget
After the medical diagnosis, you will be given an exact quote for your rhinoplasty according to the surgical plan that has been drawn up and you will also be able to book the date of your surgery. The price of rhinoplasty depends on the initial characteristics of the nose and surgical techniques.
Care Post-operative
The success of rhinoplasty is directly related to post-operative care, so it is extremely important to follow the doctor's instructions to the letter:
- Rest and avoid any kind of exertion for the first 8 days;
- After surgery, keep your head elevated with at least two pillows for the first week;
- Don't lie down all the time - it's important to get up or move your legs 3-4 times an hour to promote circulation;
- Apply ice to the area around the eyes, but be careful not to burn;
- Take the prescribed medication;
- At the end of the second day you should start cleaning the nose and some of the scabs with cotton buds soaked in hydrogen peroxide and apply the antibiotic ointment;
- While you're wearing the splint, it's important not to get it wet, so it's best to wash your head at the hairdresser;
- It's important not to sneeze, blow or rub your nose for the first fortnight after surgery;
- You can't wear glasses for four weeks so that they don't rest on your nose;
- You can return to work after 1 to 2 weeks;
- Do not expose yourself to direct sunlight;
- No smoking;
- Drink plenty of water and eat a balanced diet;
- Attend all review appointments.
What results can I expect
After Rhinoplasty?
The intervention aims to improve the appearance of the nose and optimise respiratory function, and these objectives are generally met. A fundamental aspect is to have realistic expectations of the proposed intervention, since the final result always depends on the initial characteristics of the nose, i.e. the specific clinical case.
It's not possible to apply a recipe for rhinoplasty and expect all noses to have identical results, as there are inherent characteristics to each individual and different techniques to suit each person's problems.
Rhinoplasty results are long-lasting, but the final result is expected after 6 to 12 months.
Type of Incision - Scar
Open Rhinoplasty
In open rhinoplasty, the scar is located on the columella, the tissue between the two nostrils. Although it is an external scar, in most cases it becomes practically unnoticeable over time.
Closed Rhinoplasty
Closed rhinoplasty scars are not visible because the incisions are made on the inside of the nose.
Type of Anaesthesia
In most cases, rhinoplasty is performed under general anaesthetic, but it depends on the characteristics of each patient and the techniques used.
Differences between Rhinoplasty and Rhinomodelling
Rhinoplasty and rhinomodelling are both procedures that aim to significantly improve the appearance of the nose. The “before and after” results are quite impressive. But both have different principles of action.
Rhinoplasty
- Rhinoplasty is a surgical procedure;
- It is performed in the operating theatre under local anaesthesia;
- It is recommended for patients who want to improve the aesthetic and functional aspects of their nose;
- It involves changes to the structure of the nose;
- It involves scarring (in the open approach);
- Recovery time: 1 to 2 weeks;
- The result is definitive
Rhinomodelling
- Rhinomodelling is a non-invasive treatment (without surgery);
- It is carried out in a consulting room
- It is carried out with the application of anaesthetic cream;
- It is indicated for patients who want to improve small deformities;
- It does not correct functional problems;
- It does not alter the structure of the nose;
- It doesn't leave scars;
- No recovery time;
- The result is temporary - 9 to 12 months.
2D/3D simulation nose correction
We were the first clinic in Portugal to offer real-time rhinoplasty simulation to our patients.
O Vectra XT 3D is an innovative and revolutionary piece of software that allows patients to have a very rough idea of the result that can be achieved with a rhinoplasty.
This technology allows you to visualise in real time the changes that will be made to your nose - from various angles. You can anticipate the results, weigh up your choices and better manage expectations.
Using the Vectra XT 3D has proved to be a unique and distinctive experience that facilitates communication between doctor and patient. It minimises some of the patient's reservations about the surgery and allows them to clarify more persistent doubts.
Rhinoplasty step by step
Nose marking
Before administering the general anaesthetic, markings are made on the nose.
Anaesthesia
Depending on the surgical technique in question, anaesthesia is administered (usually general anaesthesia).
Disinfection and placement of surgical drapes
The entire face and nose area is cleaned and disinfected to reduce the risk of infection. Operating drapes are placed to isolate the surgery area from the outside environment.
Incisions
Depending on the type of rhinoplasty (open or closed), the incisions are made on the inside or outside of the nose.
Nose remodelling
The nose is remodelled according to what has been discussed in consultation with the plastic surgeon.
Closing the incisions
The incisions are closed with small stitches. The internal stitches are absorbed and the external ones are usually removed after 7 days.
Recovery
The patient is woken up by the anaesthetist and then transported to the recovery room where they remain under observation until they are discharged after a few hours, on the same day.
Preparing for Rhinoplasty
Before Surgery
- Carry out all the preoperative tests requested and send them to the medical team one month before the surgery.
- Do not take aspirin or anti-inflammatory drugs two weeks before rhinoplasty.
- Do not take slimming medication one month before surgery.
- Do not smoke one month before surgery or while the healing process is underway. Smoking compromises tissue oxygenation and negatively affects healing.
- If you catch a cold or suffer from a bad mood in the days before surgery, you should inform the medical team.
- Read all the documentation you've been given carefully as there may be some questions before the day of the intervention.
- Organise your routines in advance so that you can rest and recover calmly.
- Do you have any questions about rhinoplasty surgery, preparation or the post-operative period? Don't wait until the day of your surgery and ask all your questions first.
On Surgery Day
- The day before, eat light meals that don't cause indigestion. Fast absolutely for 8 hours - do not eat or drink liquids, including water.
- Bathe with the prescribed antiseptic gel the day before and the day of the rhinoplasty to avoid infection.
- No jewellery or watches.
- Do not use creams or make-up.
- Do not use varnishes/gel/ice cream as they may interfere with the reading of vital signs.
- Do not wear contact lenses.
- Bring comfortable clothes to wear when you are discharged - preferably with buttons or zips.
- After discharge, you cannot go home alone or drive. If you don't have someone to drive you home, you must inform us in advance.
Benefits Rhinoplasty
Nose surgery improves respiratory function and enhances the appearance of the nose. Rhinoplasty allows:
- Increase or decrease the size of the nose;
- Narrow the nasal orifices;
- Narrow your nostrils;
- Correct the nasal hump;
- Straightening and aligning a crooked nose;
- Change the shape of the tip (bulbous, flat or too sharp);
- Change the angle between the nose and the upper lip;
- Improves respiratory function;
- Improves confidence and self-esteem.
Medical Specialists
About
Dr Luísa Magalhães Ramos / Plastic Surgery
DOCTORS' ASSOCIATION: registration no. 42810, specialising in Reconstructive and Aesthetic Plastic Surgery.
Graduated from the Faculty of Medicine of the University of Porto, specialising in Plastic, Reconstructive and Aesthetic Surgery, He specialised in University Hospital Centre Lisboa Central - St Joseph's Hospital.
Throughout his training, he sub-specialised in the area of Aesthetic Plastic Surgery, He has worked in world-renowned centres. At the same time, he also worked on breast reconstruction and the reconstruction of facial malformations.
He is currently working mainly on Aesthetic Plastic Surgery of the Face (eyelids, nose and cervical-facial lift), Breast Surgery and Female Genital Surgery.
About
Dr Catarina Duarte
DOCTORS' ASSOCIATION: 51027, specialising in otorhinolaryngology.
Master in Medicine from Lisbon Medical School, He then went on to specialise in Otorhinolaryngology at the Santa Maria Hospital in Lisbon, and joined the teaching staff of the Otorhinolaryngology chair as a free assistant. His training in otorhinolaryngology had a strong component in head and neck surgery, but also in rhinology, otology and paediatric laryngology.
Frequently Asked Questions about
Rhinoplasty
Are rhinoplasty scars visible?
The incisions depend on the chosen approach. In closed rhinoplasty, the incisions are made on the inside of the nose and resorbable threads are used. In open rhinoplasty, the incision is made at the level of the lower portion of the tip of the nose, between the nostrils (columella), and the thread used for the suture is removed within 4 to 7 days. In both approaches, the scars are almost imperceptible.
How does rhinoplasty recover?
The post-operative period for rhinoplasty is not usually painful and patients return to their routine between 2 and 4 days after the procedure. They may experience bruising for the first two weeks. During this period (and ideally for 2 months after surgery) it is strictly forbidden to sunbathe as it impairs healing and negatively influences the resolution of oedema. See the surgical care section for more information.
When can I see the final result of my rhinoplasty?
Immediately after surgery, you can already get an idea of the final result, although there will be some (normal) oedema and swelling in this area. Just 3 weeks after the procedure, the appearance of your nose will be very close to the final result (definitive after 2 months).
How do you choose the doctor who will perform your nose job?
Rhinoplasty is a delicate surgery and requires a lot of precision from the doctor. Choose an experienced surgeon accredited by the Portuguese Medical Association and the Portuguese Society of Plastic Surgery. Look for a professional who is available to answer your questions and explain the techniques available. To avoid disappointment, ask for examples of rhinoplasties performed by the professional.
What could be wrong with my nose?
Rhinoplasty is a personalised surgery that depends on the characteristics, dimensions and imperfections of each nose. The main aim is to functionally and aesthetically correct the nose in order to restore the patient's quality of life and self-esteem. On the other hand, it is essential to manage expectations and realise that trying to have the perfect nose or “imitate” someone else's is not feasible.
Is it necessary to break the nose to correct it?
Depending on the purpose of the rhinoplasty, it may be necessary to manipulate the bone and cartilage of the nose in order to achieve a good nasal reconstruction result. Often there may also be a cartilage graft from the nasal septum or ear pinna.
Will I get bruising in the nose area?
It depends on the person, the type of surgery and the type of fracture, but usually the bruising disappears after a week.
When are the bandages removed?
The dressings are usually removed after a week.
How long before you can start exercising again?
You should avoid intense physical exercise for 1 month. Depending on each case, you can resume light/moderate exercise 1 week after surgery.
When will I be able to return to work?
Generally, patients who undergo rhinoplasty or rhinoseptoplasty can return to work 7 to 15 days after surgery. It depends on the type of professional activity, the associated physical effort and the progress of their recovery.
What is the difference between "open" and "closed" rhinoplasty?
Closed rhinoplasty refers to a procedure in which the incisions are hidden inside the nose. Open rhinoplasty also involves a small incision in the columella, or lower part of the nose, which forms the skin and tissue between the nostrils.
Is it possible to have nose surgery with a natural result?
Yes, the aim of the procedure is to achieve a result that looks as natural and harmonious as possible. Take a look at our before and after gallery to get an idea of the results you can achieve with rhinoplasty.
Are there alternatives to rhinoplasty for correcting the nose?
Rhinomodelling is a good alternative, without surgery, to correct aesthetic (non-functional) imperfections of the nose. It is a technique that utilises tissue filling through injections of a mix of substances to sculpt the nose. This procedure requires continuous evaluation every 1 or 2 years.
I don't like the look of my nose after rhinoplasty. Is it possible to correct it?
Yes, if you've had a rhinoplasty in the past and aren't happy with the result, you can have a new operation with us. At LMR we meticulously assess the anatomy and shape of your nose and programme the surgery in detail. In every operation, we strive for a nose that is proportional, balanced and harmonious with the rest of the face. With Vectra XT 3D you can even simulate the final result in real time.
What is the price of a rhinoplasty at your clinic in Lisbon, Porto or Cascais?
Naturally, each case is different and the cost of a rhinoplasty, whether it's carried out in Lisbon, Porto or Cascais, will depend on a number of factors. At the LMR clinic you can request a quote using our contact form.
Are there any financing options or payment plans available to pay for a rhinoplasty?
Having financing options to help patients manage the cost of surgery is often a crucial factor when choosing a plastic surgeon and the clinic where nose surgery is performed. At LMR, we have payment facilities to make paying for rhinoplasty easier. Patients should be aware of the payment policies and requirements associated with these options at their initial consultation so that they can make informed decisions about financing their nose surgery. For more information on payment facilities, please contact us using the contact form or by email - geral@lmrcirurgiaplastica.pt.
Can I have a rhinoplasty if my nose hasn't finished growing yet?
Most surgeons recommend that rhinoplasty be performed after the age of 16 in women and 18 in men, as this is when the growth of the nose is usually complete. Performing the surgery too early can affect the final result, as the nose may still be developing.
Can rhinoplasty be performed on people with a deviated nasal septum?
Yes, rhinoplasty can correct both the aesthetic and functional parts of the nose. If you have a deviated nasal septum, the surgeon can perform a rhinoseptoplasty, which is a combination of cosmetic rhinoplasty and correction of the nasal septum to improve breathing.
